Thrombotic Thrombocytopenic Purpura In A Patient With Snake Bite

Snakebite envenomation is a common scenario in southern India. Among the various causes of acquired thrombotic thrombocytopenic purpura (TTP), snake bite envenomation is very rarely reported. We present a rare case of a 51-year-old man with TTP following snakebite envenomation. He developed features of TTP including impaired neurological state, renal dysfunction, low platelets, fever, microangiopathic hemolytic anemia on day 5 following snakebite. He received 7 cycles of plasma exchange and showed remarkable improvement. We are presenting this case to create awareness regarding TTP following snakebite as it has a very significant implication on treatment and mortality.

Detection of comorbid illnesses during pre-anaesthesia evaluation in a university teaching hospital: A prospective observational study.

Background. Consultation for surgery and anaesthesia is often the first point of contact with a healthcare provider for a majority of patients in developing countries. In India, where patients have poor access to healthcare, they are likely to present with uncontrolled/untreated/undetected coexisting diseases. However, there is little published literature on this aspect. We hypothesized that many of our patients will present to our pre-anaesthesia evaluation clinic (PAC) with undetected comorbid illnesses and will require proper assessment, treatment and optimization before surgery. Thus, we aimed to assess the frequency and type of comorbid illnesses in patients attending the pre-anaesthesia clinic for elective surgery. Methods. We did a prospective observational study on all patients evaluated in the PAC of our university teaching hospital over a 3-month period to assess the frequency and type of comorbid illnesses. The data recorded included demographic profile and presence of coexisting illness and was classified as preexisting or newly diagnosed at the time of the visit to the PAC. The data were then tabulated and analysed statistically using SPSS software version 14.0. The frequency and percentage of occurrence for each comorbid illness was determined. Results. Of 3973 patients, 242 (6%) had 304 comorbid illnesses (135 cardiac, 54 endocrine, 15 respiratory, 12 others). Of these 88 (29%) were newly detected comorbid conditions (69 cardiac, 9 endocrine, 9 respiratory, 1 others). The most frequent comorbid illness both pre-existing and newly diagnosed were cardiac. Hypertension was the commonest problem in our study population (168 patients). Conclusion: We confirmed that a PAC can detect hitherto undetected comorbid illnesses which are likely to impact the perioperative process.